Académique Documents
Professionnel Documents
Culture Documents
18 Havelock Road
Singapore 059764
www.mom.gov.sg
Personal Particulars
Foreign Identification Number / Work Permit Number (if applicable)
Travel Documents / Passport Information
Educational Details
MOM regularly updates its forms. The copy that you have downloaded more than 30 days ago may be outdated, and may
not be used. To ensure that you use the latest version, please download the latest copy at http://www.mom.gov.sg.
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INSTRUCTIONS:
1. For *, please check relevant boxes.
2. Indicate Not applicable or N.A. when necessary. Do not leave any blank. Incomplete applications may not be processed.
3. Please email the duly completed application form and required supporting documents to mom_whp_wpd@mom.gov.sg for
processing. For non-English degree certificates/transcripts/letter from the university/college on your student status, you must
submit a copy of the original as well as the official English translation certified by the university/college.
4. A valid email address is compulsory to allow the Ministry of Manpower (MOM) to correspond with you directly on the status of
your application.
5. To check whether your application has been received, you may email mom_wpd@mom.gov.sg if you do not hear from the
Ministry of Manpower after two weeks.
Foreign Identification No. (FIN): (Applicable if you have ever held a long term pass to either work/study/live in Singapore)
Work Permit No. (WP No): (Applicable if you have worked in Singapore on a Work Permit)
Given Name:
Alias: (if applicable)
Family Name/ Surname:
Given Name:
Malaysian Identity Card Colour:* Blue Pink
Race:* Religion:*
Caucasian Chinese Indian Buddhist Christian Free Thinker Hindu
Malay Others Muslim Others Sikh Taoist
Address in Singapore
Block/House Number: Floor Number: Unit Number: Building Name:
Email: (MOM will correspond with you via this email address) Tel Number:
Travel Document Type:* Hong Kong Special Admin Region International Cert of Identity
International Passport Macau SAR Travel Permit
Name of Awarding Body / Institution / University which awarded/will be awarding the qualification:
Academic and Professional Qualifications awarded/will be awarded: (Note: for Honours Degree, state class/division)
Faculty of Study:
From: / To: /
Status*: Completed and awarded qualification Currently pursuing qualification Gap year
If you are planning to submit your application early, make sure it is not more than three months from your intended travel
date.
(a) Have you ever been refused entry into or deported from any country? Yes No
(b) Have you ever been convicted in a court of law in any country? Yes No
(c) Have you ever been prohibited from entering Singapore? Yes No
(d) Have you ever entered Singapore using a different passport or name? Yes No
(e) Have you ever been a Singapore Citizen or Singapore Permanent Resident? Yes No
(f) Are you currently a Singapore Citizen or Singapore Permanent Resident? Yes No
(a) I confirm that the information as set out in Parts I-II & IV is provided by me and that the said information is true and correct.
(b) I give my consent to the Government of Singapore to obtain from and verify information with any person, organisation or any
other source for assessing my application.
(c) I understand that I may be subject to prosecution if I have provided any information, which is false in any material particular
or is misleading by reason of the omission of any material particular.
(d) I am fully aware of the requirements that I need to meet for the grant of the Work Holiday Pass.
(e) I shall ensure that I have sufficient funds to finance my stay in Singapore.
(f) I shall ensure that I have the necessary personal insurance coverage for any medical expenses incurred during my stay in
Singapore.
(g) I shall be responsible for making sure I depart Singapore no later than the expiry of my pass. I shall also show proof of return
or onward journey from Singapore prior to the collection of the pass.
(h) I shall be responsible for the compliance of any quarantine and medical surveillance imposed on me under regulation 8(2A)
of the Immigration Regulations.
I have read and fully understood, and I agree to abide by all Terms and Conditions of the Work Holiday Pass set forth above.